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47 Cards in this Set
- Front
- Back
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Indications for blood transfusion? (4)
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Hb<7g/dL
Acute>chronic bleed Co-morbidity e.g. isch heart disease Patient symptomatic |
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Giving transfusion to patients with heart failure, what can be added to ensure patient safety?
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Co-prescribe furosemide
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Common cause of B12 deficiency causing anaemia? (4)
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Alcoholism
Pernicious anaemia IBD - crohns + UC Dietary (vegans) |
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What is schilling's test?
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Investigation pernicious anaemia
Patient given radioactive B12 - im + oral and measure B12 in urine. |
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Where is Vit B12 absorbed in the gut?
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Terminal ileum (hence decreased in crohns)
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What is a megaloblastic anaemia?
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B12 + folate deficiency lead to megaloblastic anaemia.
A megaloblast is a cell with immature nuclei. Blood film often shows hypersegmented neutrophils. Causes: Pernicious anaemia, folate + B12 def, coeliac disease |
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Non megaloblastic cause of macrocytic anaemia?
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Alcohol
Haemolysis Liver disease Hypothyroidism Pregnancy |
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What is aplastic anaemia?
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Bone marrow fails to produce sufficient blood cells = Pancytopenia usually idiopathic.
Can be secondary to bone marrow failure (myeloma, acute leukaemia, myelodysplasia, lymphoma, tumours, myelofibrosis, SLE, hypersplenism) |
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What is fanconi anaemia?
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Autosomal recessive disorder leading to an aplastic anaemia.
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Features assoc fanconi anaemia?
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Increased risk AML
Absent radii Short stature Microcephaly Syndactyly (fingers fused) Cryptorchidism (absence 1 or both testis) Deafness Low IQ |
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Causes normochromic normocytic anaemia?
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Chronic disease
Aplastic anaemia Blood loss Haemolytic anaemia (some) |
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Ix autoimmune haemolytic anaemia?
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Normochromic normocytic anaemia
Unconjugated hyperbilirubinaemia Direct coombs test +ve NB can subdivide these into warm + cold types based on whether coombs test bind best under or over 37 C |
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Common cause of warm autoimmune haem anaemia?
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SLE
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Diagnosis of AML
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Myeloblasts in marrow + blood
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Intrinsic pathway is.....
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8,9,11,12
Measure APTT |
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Extrinsic pathway is....
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7, 10
Measure INR (PT) |
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Final common pathway....
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Prothrombin, thrombin, fibrinogen, fibrin, XIII
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Rx DVT in pregnancy?
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Warfarin (INR2-3)
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Rx PE in pregnancy
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Thrombolysis
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Rx patients with peptic ulcer disease (not currently bleeding) needing anti-coagulation after surgery?
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Low molecular weight heparin (e.g. enoxaparin)
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Rx patient AF where warfarin is contraindicated?
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Phenindione
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Rx antiphospholipid syndrome?
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Warfarin aim INR 3-4.5
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Sx antiphospholipid syndrome?
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AA + VV thrombosis
Migraine Miscarriages Thrombocytopenia Livedo reticularis Rx lifelong warfarin aspirin decreases risk miscarriage |
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FBC suggesting megaloblastic anaemia?
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Macrocytosis
Neutropenia Anaemia 2nd B12 or folate def |
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Phenytoin can cause what anaemia?
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Folate def in epileptics (megaloblastic anaemia)
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A microcytic anaemia presenting at pregnancy is suggestive of?
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beta Thalassaemia minor
Suggested by a fall in MCV with an increase in RCC |
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Multiple myeloma is commoner in who?
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Afro-carribean
Men Elderly IX: boney pain + hypercalcaemia |
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Causes of eosinophilia? (8)
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Metazoa (not protozoa) infection.
Hookworm Hodgkins lymphoma Asthma Bronchial aspergilloma Churg straus PAN Loefflers endocarditis Pulmonary eosinophilia |
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Increased bleeding time in....(2)
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vW disease
Immune thrombocytopenic purpura NB increased in factors affecting platelets. In factors affecting clotting factors e.g. haem A + B no increase is seen. |
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Iron levels in Fe def anaemia? (3)
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Serum iron + ferritin levels are low.
TIBC often raised |
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Microcytic anaemia is due to? (4)
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Thalassaemia
Fe def Vit A+C def |
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Megaloblastic anaemia is due to deficiency of...? (3)
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B12
Folate Cobalamin |
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Where is Fe absorbed?
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Duodenum
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Red cell destruction is associated with which biochemical results?
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Decreased haptoglobulins - these bind free haemoglobin and may drop if severe haemolysis
Increased methaemalbumin - which is the way haemoglobin when needs cannot be met by haptoglobins Haemosiderinuria - brown urine secondary to haemolysis. Yet another haemoglobin storage structure lost in urine. |
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What is haemolytic anaemia of the newborn?
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ABO mediated autoimmune reaction
Is less severe than Rh mediated haemolysis |
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Ix of DIC?
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Increased APTT, PT, TT
Decreased fibrinogen High d-dimer/fibrin degrad products Shistocytes (fragmented RBCs - microangiopathic haemolysis) |
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Crisis in sickle cell disease?
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Aplastic - 2nd to parvovirus B19 infect
Veno-occlusive - with priapism and mesenteric dysfunct Sequestration - hypersplenism leading to anaemia and shock |
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Use of hydroxyurea in sickle cell disease?
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Raise HbF to prevent painful crisis
SE = neutropenia |
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Low TIBC suggests?
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Fe def anaemia
Anaemia chronic disease |
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Causes of low MCV?
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Fe def anaemia
Thalassaemia Anaemia chronic disease Sideroblastic anaemia Lead poisoning |
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What is sideroblastic anaemia?
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Ineffective erythropoiesis leading to increased iron absorption
Causes: idiopathic, myelodysplasia, chemo, radio |
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Causes of macrocytic anaemia?
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2 Types
1) Megaloblastic - B12, folate 2) Non megaloblastic - alcohol, liver disease, hypothyroidism, pregnancy, reticulocytosis, drugs (chemo, azathioprine) |
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What is ITP?
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Immune thrombocytopenic purpura - antiplatelet autoantibodies. Assoc with illness in kids.
Sx: epistaxis + menorrhagia in women Ix: thrombocytopenia |
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Appearance FBC in B12 def
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Megaloblastic anaemia
+ Hypersegmented neutrophils + thrombocytopenia |
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Ix vWf disease?
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APTT + PT = normal
Decreased platelet adherance = increased bleeding time Rx: recombinant factor VIII |
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Appearance of blood film in pt with hereditory Elliptocytosis?
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Elliptocytes (cigar shaped red blood cells)
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Where is folate absorbed?
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Jejunum (therefore coeliac disease can lead to a macrocytic anaemia - fe def more common)
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